Breathing New Life Into CPR

Few of us know how to do cardiopulmonary resuscitation (CPR), yet all of us should. Now, there's no reason not to learn.

Under new American Heart Association (AHA) guidelines, training programs on cardiopulmonary resuscitation, better known as CPR, have become shorter and simpler. You can even buy an inexpensive kit that can teach you CPR in about a half hour at home.

Home lies at the heart of the new approach. That's because most heart-stopping emergencies take place in the home. The life you save by knowing CPR could be one dear to you.

"Whether it's a mother with a small child at home or in the workplace, you never know when you'll have the opportunity to save a life," says Mary Fran Hazinski, R.N., M.S.N., a clinical nurse specialist who helped write the AHA guidelines.

When someone suffers cardiac arrest and stops breathing, the first thing you should do is call 911. But it will take a few minutes for help to reach you. Those minutes are crucial.

Improved survival

The survival rate for cardiac arrest victims is just 6 percent, Hazinski says. But that rate improves if someone starts CPR at once and keeps it up until the victim gets an electrical shock from an automated external defibrillator (AED) to restore the heartbeat. With early CPR and defibrillation, combined with early medical care, the survival rate can reach 50 percent, the AHA says.

Many people think CPR training is too long and complex. There are too many things to learn, too much to remember in an emergency. You have to check the victim's pulse, place one hand over the other in the center of the victim's chest, begin compressions, stop after every 30 compressions to breathe twice into the victim's mouth, resume chest compressions, recheck the pulse, and so on.

In 2005, the AHA says, a review found flaws in the way CPR was being taught and done.

"Health care providers were not compressing the chest deeply enough and were interrupting the compressions too frequently. Victims were getting [far] too few compressions," Hazinski says.

Researchers decided we should concentrate on the basics. The key: Start chest compressions right away and keep doing them at a rate of 100 per minute (about two per second) with as few interruptions as possible.

Forget the pulse

Checking for a pulse? Skip it. "Studies have shown even medical students have trouble learning if a person has a pulse," says Michael Sayre, M.D., an emergency medicine specialist.

Giving two rescue breaths for every 15 chest compressions? Cut that in half. Experts found the most important thing is to start and maintain blood flow. Halting chest compressions halts blood flow. The new rules call for two breaths before you start compressions, and then two breaths after every 30 compressions.

And those chest compressions? Make sure they're deep enough—1-1/2 to 2 inches.

"The focus of CPR courses now is to simplify the training and practice it—practice it until it becomes second nature," says Vinay Nadkarni, M.D., an anesthesia and critical care specialist.

The AHA has created "CPR Anytime for Family and Friends," a kit you can buy to learn CPR in about 30 minutes. The kit includes an inflatable practice mannequin and a 22-minute DVD. To order, visit the AHA website at http://www.cpranytime.org.

Whether you're trained or not, don't hesitate to do CPR in an emergency. Operators at 911 can talk you through it—or you can just do your best. "Even lousy CPR is better than no CPR," Dr. Sayre says.

The basics

Here's a rundown from the AHA on the latest version of the adult CPR procedure:

Check to see if the person is breathing. Can you awaken the person? If not, assume the person is in cardiac arrest.

Have someone call 911.

Give two breaths and immediately begin chest compressions.

Give 30 chest compressions, then give two more rescue breaths.

Continue this cycle until emergency medical help arrives.

To breathe or not to breathe

In 2008, the AHA published guidelines for "hands-only" CPR, in which chest compressions only are performed without rescue breathing. These AHA recommendations apply only to adult victims whose collapse is witnessed. The recommendations do not apply to children, unwitnessed cardiac arrest or collapse, or when cardiac arrest is presumed to be from non-cardiac causes. The "hands-only" recommendations from the AHA are:

Bystanders of a witnessed collapse/arrest who are not trained in CPR should provide "hands-only" CPR until an AED arrives or emergency personnel arrive on scene.

Bystanders who have been previously trained in CPR who are confident in their ability to provide rescue breaths with minimal disruption of chest compressions should provide either conventional CPR or "hands-only" CPR until an AED arrives or emergency personnel arrive on scene.

Bystanders who have been previously trained in CPR but who are not confident in their ability to provide conventional CPR with rescue breathing should provide "hands-only" CPR until an AED arrives or emergency personnel arrive on scene.